An Avalanche of Errors Led to the False Missile Alert in Hawaii

The FCC heard a preliminary report from an investigation into what went wrong.

I’d call it a comedy of errors, but there was really nothing funny about millions of people believing they had mere moments left to live. Ever since the Hawaii Emergency Management System sent out a false alert of an incoming ballistic missile attack on January 13, only to later announce it was a mistake, people wanted to know what happened.

At Tuesday’s Federal Communications Commission hearing, we finally got some of those answers, and the truth is there wasn’t one thing that went wrong, it was an avalanche of errors.

“The panic and fear and heartache of those 38 minutes, we now believe, was due to human error but also deficient preparation and training,” said FCC Commissioner Brendan Carr. “No one should have to go through moments like those, especially if basic competency would have prevented it.”

The FCC ordered an investigation into the alert immediately after it was clear that it had been a false alarm, and the agency’s Public Safety & Homeland Security Bureau (PSHSB) delivered its preliminary findings Tuesday. Investigators found a string of errors—many that could have been prevented through better protocols—that led to the terrifying mistake.

Part of the problem was that the Hawaii EMA had been running no-notice drills for a year, meaning workers never knew when a drill was coming. These drills consisted of a recorded voice message being sent to on-duty workers, and typically the drill only includes an internal alert, not any actual public message, explained James Wiley, the attorney advisor for the PSHSB.

But on that Saturday, there was also a misunderstanding that led to there being no supervising officer on the floor when the drill began—the incoming supervisor thought the drill was for the ending shift workers, not the incoming shift. Normally, there would be a supervisor on the floor to prevent errors like this, but due to the misunderstanding, there wasn’t that morning.

Then, there was the internal drill message that was sent out to workers which, despite opening and closing with the words “exercise, exercise, exercise,” also included the words “this is not a drill.” According to Wiley, the worker who ultimately sent out the public alert claims they thought the internal message was real, and didn’t hear the “exercise, exercise, exercise” part, even though other workers on duty realized it was a drill. However, Wiley said investigators have “not been able” to speak with the employee who sent the warning. Last week, CNN reported the employee has refused to speak with FCC investigators.

The internal alert system used also has no safeguards—such as requiring two-person authentication or a supervisor sign off—to prevent a single individual from sending out a warning, Wiley noted. All a worker has to do is select the warning and confirm.

Screengrab from the Powerpoint presentation/PSHSB

Things only got worse after the alert was sent out, because the Hawaii EMA had no protocols in place to deal with a false alarm. This delayed the message getting out to the public that there was no threat.

“The most troubling part is that, at many levels, this mistake could have been avoided and its effects could have been mitigated,” said Commissioner Jessica Rosenworcel.

If the supervisor had understood which employees would be running the drill, or the employees knew it was coming, or the correct message had been sent, or the program didn’t allow for one person to decide whether or not to send a missile warning to the entire state of Hawaii, or the HEMA had any kind of plan in place to react quickly if something like this ever did happen, this calamity could have been avoided. The only benefit is that now emergency management agencies at all levels can learn from these mistakes and set things up to better safeguard against future errors.

The investigation will have a final report in coming weeks, including recommendations of what changes can be made to HEMA’s drill procedures and other emergency alert systems. In the meantime, HEMA has suspended all emergency message drill tests.